I was prescribed an NPEP regiment after a condom break with my boyfriend of 1.5 months (I was anal receptive). He had a high risk exposure (anal receptive and insertive) with an HIV+ partner in April. He told me that he tested negative at the 4 month mark (what he *meant* to tell me and later did was that the tests were not conclusive...is this even possible?). He was going to get retested that next week, so I bought a week's worth of Truvada, because I don't have insurance (full 28 days costs around $1000) and the chances he would test positive after a negative test at 4 months seemed really small anyway.

So I took the pills for a week, and he came up with an excuse to not get his HIV test results back (before his Dr.'s office closed for the Holidays--couldn't get them over the phone).

Rationalizing, and without the money to buy the drugs, I stopped NPEP after a 5 day course.

Fast forward to two days ago, and I told him I couldn't be with him anymore unless we both went to an HIV testing place and got an instant antibody test.

His was HIV+. Mine was HIV- at 26 days (3 weeks) after exposure.

So 2 questions:

1) Will 5 days of NPEP started at around 55 hours (agnoizing) after exposure substantially push back my window period (past 3 or 6 months)? Im in college and it looks like my final semester is going to be spent thinking about HIV infection instead of being in the happy, stable, monogomous, STD worry free relationship I thought I was finally settling into. Really ironic. In years of random hook ups, this has been the highest risk exposure I have ever had.

2) Is this guy lying to me? I don't want to believe he is, that someone would lie about their HIV status, but between the 2 times he had excuses to avoid testing and the insistance that I stay on NPEP (as well as some of the other stuff he has said about the reliability of testing and false negatives, also he said "I am going to act like I'm positive, despite the 4 month mark testing")) it really makes me wonder if he could have not known he was HIV+ between April and today. Also, I saw the condom "tear" and thought that just doesn't really happen. Not sure if I am paranoid or if this guy is ...not being honest. I am 22 and he is 33; I have a lot less relationship experience that he does, and he is a very charming guy. I don't want to break up with him just because he's postive and he seemed really devestated afterwards (that said he got high and went drinking with his family the day after), but I can't help thinking he has lied to me and endangered my life.

Also, what lesson should I learn from this? Any advice appreciated. I felt like safe sex with condoms, unlikely positive after 4 months, monogomous, and dating for a month and a half...I don't know what I should have done differently. And discontinuing the NPEP made sense after the risk really did seem minimal (small condom tear, HIV neg partner at 4 months), getting money from my friends and family for $1k for AIDs medicine was gonna be impossible, and the side effects were making me sick.

Any sage wisdom? Do I need to test a year out?

Happy New Year

Response from Dr. Frascino

Hello,

Once again we see the consequences of folks not having health insurance. That Truvada costs $1,000 for a 28-day supply is absurd and frankly immoral! Health care reform can't get here soon enough!

Turning to your questions:

Your five days of Truvada will not alter your HIV window period.

I have no way of knowing if your boyfriend was lying to you or not. I, too, would like to believe that HIVers would not lie about their status, but unfortunately I know of many situations where not only non-disclosure but also outright lying has occurred.

As for lessons to be learned, the biggest is that not having health insurance can be catastrophic, even for a young healthy college student. Had you had health insurance, you would not be in this conundrum. You would be finishing a course of nPEP and have appropriate medical followup. Other lessons: (1) nPEP should be taken as soon as possible after an exposure. The longer the time interval between exposure and first does, the less likely nPEP will be effective in aborting an HIV infection. nPEP is not warranted if more than 72 hours have lapsed since exposure. (2) Everyone should review proper condom use. They very seldom fail (break) when used properly. And remember, lubrication is your friend!

I applaud your efforts to be safe (condoms, monogamous partner, etc.). You do not need to test out to a year. The CDC guidelines for your situation (significant exposure to someone confirmed to be HIV infected) recommend testing at the three-month and six-month marks.

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